Emotions, Strategies, and Health: Examining the Impact of an Educational Program on Tanzanian Preschool Children.

Around the world, well-produced television programming can engage vulnerable, hard-to-reach audiences by offering informal education and enrichment. Akili and Me is an animated children's educational program available in Sub-Saharan Africa that provides age and culturally appropriate lessons. In 2018, the producers created socio-emotional and health content. This study examines the relationship between children's exposure to the new Akili and Me content and socio-emotional and health outcomes. Participants included low-income school children (mean age 5.32 years, SD = 0.82) from Arusha, Tanzania. Researchers conducted one-on-one baseline and post-intervention surveys with each participant. Over 12 weeks, the children attended afterschool sessions with screenings of Akili and Me, with distinct content screened on different days. The research team recorded children's attendance and assessed children's receptivity to the program through character identification. Using MLM regression models with data from 411 participants from 10 public schools, the analyses showed that a greater exposure and receptivity to Akili and Me predicted improved outcomes scores on the socio-emotional and health outcomes, controlling for sex, age, baseline scores, and general media receptivity (non-Akili and Me characters). Contributing to the literature on educational media, this study shows that exposure to an animated program can teach vulnerable preschool children socio-emotional and health content.

"People Will Continue to Suffer If the Virus Is Around": A Qualitative Analysis of Sub-Saharan African Children's Experiences during the COVID-19 Pandemic.

Children are particularly impressionable and at risk during a global public health crisis, making it essential to examine their unique perspectives. To hear and understand sub-Saharan African children's experiences with the COVID-19 pandemic, we conducted an exploratory qualitative analysis based on interviews with 51 children, ages 9 to 13, from Nigeria, Tanzania, and Sierra Leone. Applying the organization of Bronfenbrenner's ecological systems theory, we reveal how COVID-19 affected children's daily lives and domestic challenges, schooling and neighborhood issues, media use (and its relationship to knowledge and fear of the disease), perceptions of the country, and government response, and thoughts of religion and hope. Children's responses dif-fered greatly, but patterns emerged across sex, age, household size, religion, and country. This study offers guidance and recommendations for meeting the needs of children, especially in times of crisis.

The relation between knowledge and concern: A global study of children and COVID-19.

COVID-19 messages vary around the world, and populations receive these messages in different ways. Children are a vulnerable audience, especially in terms of risk communication. As messages are being developed, communicated, and disseminated about this pandemic, it is important to know the relation between COVID-19 knowledge and concern among preadolescents. In Spring 2020, children (N= 4,249) from 8 global regions completed an online survey (Mage= 11.0, 54% female, 46% male). We assessed children's COVID-19 knowledge by asking about prevention and symptoms, as well as myths about the virus. We also assessed children's concerns by asking about worries about self and others getting sick, missing school, and interruption of activities. Our analyses revealed different relations between knowledge and concern by region. Among children from Sub-Saharan Africa, the Arabian region, Asia, and North America, there was a positive relation between knowledge and concern. For those from Latin America, Oceania, Europe, and Southeast Asia, the relation was flat or negative. When producing messages for children during a public health crisis, health communicators must know that more knowledge is not always associated with less concern.

"People Will Continue to Suffer If the Virus Is Around": A Qualitative Analysis of Sub-Saharan African Children's Experiences during the COVID-19 Pandemic.

Children are particularly impressionable and at risk during a global public health crisis, making it important to examine their unique perspectives. To hear and understand sub-Saharan African children's experiences with the COVID-19 pandemic, we conducted an exploratory qualitative analysis based on interviews with 51 children, ages 9 to 13, from Nigeria, Tanzania, and Sierra Leone. Applying the organization of Bronfenbrenner's ecological systems theory, we reveal how COVID-19 affected children's daily lives and domestic challenges, schooling and neighborhood issues, media use (and its relationship to knowledge and fear of the disease), perceptions of the country and government response, and thoughts of religion and hope. Children's responses differed greatly, but patterns emerged across sex, age, household size, religion, and country. This study offers guidance and recommendations for meeting the needs of children, especially in times of crisis.

Constancy (the New Media "C") and Future Generations.

In the past, researchers would consider media's impact on youth in terms of three "Cs": consumption, content, and context. This article introduces a new construct-constancy-which supplants the previous terms. Constancy refers to the ubiquitous and continuous state of connected screens in the lives of children and adolescents. Constancy characterizes media content and use, which can be proactive, incidental, or contextual, exerting positive or negative effects on different users. Constancy can influence child development, as persistent access to smartphones and reception of messages will affect future generations' cognition and education, social interactions, emotions, and health. It will be important to address the developmental needs of the child or adolescent and not the smartphone in his or her pocket. Constancy requires pragmatic and innovative methodologies to understand the new circumstances around children, adolescents, and media. The landscape has changed and so must our approach to research and investigation of media effects.

Prospective predictors of flavored e-cigarette use: A one-year longitudinal study of young adults in the U.S.

INTRODUCTION: E-cigarettes with fruit and candy flavors are appealing among young adults. This study examined the prospective predictors of young adults' flavored e-cigarette use to inform regulation and prevention efforts. METHODS: We used the wave 1 (2013-2014) and wave 2 (2014-2015) data of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort study of U.S. youth and adults. We analyzed a sample of young adults aged 18-34 (n = 12,383) to identify wave 1 prospective predictors (i.e., socio-demographic characteristics, mental health symptoms, marijuana use, tobacco use, and e-cigarette harm perceptions) of wave 2 flavored e-cigarette use. RESULTS: At wave 2, 8.0% of young adults used e-cigarettes, and 2.5% and 5.5% used tobacco and menthol (TM) and non-tobacco and non-menthol flavors (NTM) flavors, respectively. In the multivariable model, significant prospective predictors (wave 1) of NTM flavored e-cigarette use compared to TM flavored e-cigarette use (wave 2) were younger age (18-24 years) (AOR = 1.82, p < 0.001), female gender (AOR=1.81, p < 0.001), education attainment of high school graduate and higher (AOR=1.60, p = 0.024), marijuana use (AOR=1.96, p < 0.001), ever but non-past-month cigarette smoking (AOR=2.75, p < 0.001), never cigarette smoking (AOR=5.08, p = 0.016), and lower harm perception of e-cigarettes (AOR=1.59, p = 0.005). CONCLUSION: This study highlights high rates of NTM flavor use and specific predictors of NTM flavored e-cigarettes use among young adults in the U.S. Regulation and prevention efforts for curbing flavored e-cigarette use among young adults should focus on these risk factors and high-risk groups (e.g., 18-24 years, female, and never cigarette smokers).

Flavored E-cigarette Use and Cigarette Smoking Susceptibility among Youth.

OBJECTIVES: Research indicates youth e-cigarette use may lead to the use of conventional cigarettes, but the specific effects of flavored e-cigarettes-which greatly appeal to youth-are unknown. Therefore, this study examines how flavored e-cigarette use predicts cigarette smoking susceptibility among youth non-smokers. METHODS: We used 2014 National Youth Tobacco Survey to explore the relationship between current e-cigarette use (non-use, flavored and plain e-cigarette use) and smoking susceptibility among 18,392 youth non-smokers (ages 11-18 years). RESULTS: Overall, 2.2% and 2.1% of non-smoking youth currently used plain and flavored e-cigarettes. Compared to 30.0% of non-users, 61.1% and 74.1% of plain and flavored e-cigarette users reported smoking susceptibility. Flavored e-cigarette users were more likely to be susceptible than plain e-cigarette users (AOR=1.7, p< .001) and non-users (AOR=3.8, p< .0001). The magnitude of the relationship between flavored e-cigarette use and smoking susceptibility was significantly higher for females (AOR=6.5, p< .01) than males (AOR=2.5, p< .01). CONCLUSIONS: Flavored more so than plain e-cigarette use is strongly associated with smoking susceptibility among non-smoking youth. Flavored e-cigarettes are recruiting females and those with low smoking-risk profile to experiment conventional cigarettes. Legislative efforts to ban e-cigarettes with child-friendly flavors should be enhanced.

Tobacco cues in India: An ecological momentary assessment.

BACKGROUND: Tobacco use in India is a major health concern; however, little is known about the influence of tobacco-related social and environmental cues on tobacco use. This study uses ecological momentary assessment (EMA) to examine real-time tobacco use and exposure to social and environmental cues. METHODS: In Hyderabad and Kolkata, participants were recruited, and an EMA application was installed on their mobile phones. Momentary prompts (MP) were randomly used to collect real-time information and end-of-day (EOD) prompts gathered retrospective information on daily basis. Besides personal tobacco use, the surveys asked about exposure to social (e.g., presence of others using tobacco) and environmental cues (e.g., visual and olfactory stimuli). Using the data aggregation approach, bivariate and multivariate analyses were performed to examine the association of tobacco use and cue exposure. Moderating roles of participants' socio-demographic characteristics were also tested to gain an in-depth understanding of the relationship. RESULTS: Among the 205 participants, around a third (MP, 33.7 %; EOD, 37.6 %) used tobacco at least once during the study period. Tobacco-related social and environmental cues related were commonly reported. In the bivariate models, tobacco use was associated with gender, age, and all the examined social and environmental cues except for seeing restrictions on tobacco use. In the multivariate models, tobacco use was associated with age, gender, seeing others using tobacco, and seeing restrictions on tobacco use. Seeing others in one's immediate group using tobacco was the strongest predictor of tobacco use in both MP and EOD assessments. Gender and age did not moderate the relationship between cue exposure and tobacco use, although males reported higher tobacco use and cue exposure in general. CONCLUSIONS: This research provides data on the ubiquity of social and environmental tobacco cues in India. The EMA approach was feasible and informative. Future cessation interventions and advocacy efforts should address the high prevalence of tobacco use and exposure to pro-tobacco use cues especially among Indian males. Health education campaigns for promoting tobacco use restrictions in private places as well as changing the norms of tobacco use in social settings are recommended.

"It's got to be on this page": age and cognitive style in a study of online health information seeking.

BACKGROUND: The extensive availability of online health information offers the public opportunities to become independently informed about their care, but what affects the successful retrieval and understanding of accurate and detailed information? We have limited knowledge about the ways individuals use the Internet and the personal characteristics that affect online health literacy. OBJECTIVE: This study examined the extent to which age and cognitive style predicted success in searching for online health information, controlling for differences in education, daily Internet use, and general health literacy. METHODS: The Online Health Study (OHS) was conducted at Johns Hopkins School of Public Health and Stanford University School of Medicine from April 2009 to June 2010. The OHS was designed to explore the factors associated with success in obtaining health information across different age groups. A total of 346 men and women aged 35 years and older of diverse racial and ethnic backgrounds participated in the study. Participants were evaluated for success in searching online for answers to health-related tasks/questions on nutrition, cancer, alternative medicine, vaccinations, medical equipment, and genetic testing. RESULTS: Cognitive style, in terms of context sensitivity, was associated with less success in obtaining online health information, with tasks involving visual judgment most affected. In addition, better health literacy was positively associated with overall success in online health seeking, specifically for tasks requiring prior health knowledge. The oldest searchers were disadvantaged even after controlling for education, Internet use, general health literacy, and cognitive style, especially when spatial tasks such as mapping were involved. CONCLUSIONS: The increasing availability of online health information provides opportunities to improve patient education and knowledge, but effective use of these resources depends on online health literacy. Greater support for those who are in the oldest cohorts and for design of interfaces that support users with different cognitive styles may be required in an age of shared medical decision making.

The relationship between population-level exposure to alcohol advertising on television and brand-specific consumption among underage youth in the US.

AIMS: We investigated the population-level relationship between exposure to brand-specific advertising and brand-specific alcohol use among US youth. METHODS: We conducted an internet survey of a national sample of 1031 youth, ages 13-20, who had consumed alcohol in the past 30 days. We ascertained all of the alcohol brands respondents consumed in the past 30 days, as well as which of 20 popular television shows they had viewed during that time period. Using a negative binomial regression model, we examined the relationship between aggregated brand-specific exposure to alcohol advertising on the 20 television shows [ad stock, measured in gross rating points (GRPs)] and youth brand-consumption prevalence, while controlling for the average price and overall market share of each brand. RESULTS: Brands with advertising exposure on the 20 television shows had a consumption prevalence about four times higher than brands not advertising on those shows. Brand-level advertising elasticity of demand varied by exposure level, with higher elasticity in the lower exposure range. The estimated advertising elasticity of 0.63 in the lower exposure range indicates that for each 1% increase in advertising exposure, a brand's youth consumption prevalence increases by 0.63%. CONCLUSIONS: At the population level, underage youths' exposure to brand-specific advertising was a significant predictor of the consumption prevalence of that brand, independent of each brand's price and overall market share. The non-linearity of the observed relationship suggests that youth advertising exposure may need to be lowered substantially in order to decrease consumption of the most heavily advertised brands.

Patterns of media use and alcohol brand consumption among underage drinking youth in the United States.

This study investigated whether underage drinkers with varied media use patterns differentially consume popular brands of alcohol. A survey was conducted with a national online panel of 1,032 underage youth 13-20 years of age who had consumed at least 1 drink in the past 30 days. A latent class analysis identified four distinct media use patterns. Further analyses explored whether these media use groups differentially consumed the most frequently used alcohol brands. The results showed that past 30-day consumption of specific alcohol brands differed significantly across the four media use clusters, even after controlling for sex, race/ethnicity, household income, U.S. geographic region, frequency of parent's alcohol overconsumption, cigarette smoking, and seatbelt use. This study shows that youth use media in different ways, and this differential use is significantly associated with the consumption of specific alcohol brands. The media clusters revealed in this analysis may inform future research about the association between specific alcohol media exposures and individual brand consumption.

Well, that's what came with it. A qualitative study of U.S. mothers' perceptions of healthier default options for children's meals at fast-food restaurants.

INTRODUCTION: Using a qualitative design, this study investigated mothers' perceptions of food choices and default options, for children, at fast-food restaurants. STUDY DESIGN: Mothers of 3- to 8-year-old children (n = 40) participated in phone interviews. RESULTS: Mothers praised fast-food restaurants for offering healthier choices, but voiced concerns about quality of the food. Half worried about meat products and several were distressed by the processing involved with food and beverages. Many said that their children wanted to visit fast-food restaurants because of advertised toys and not food offerings. Half liked bundled meals, as long as they could choose the specific items that were included. Having healthier defaults might eliminate battles, reduce forgetfulness and facilitate ordering. Most mothers favored healthier defaults because it would help "other parents." CONCLUSION: This small study provides strong support for offering healthier options at fast-food restaurants. Restaurants, schools and other food venues should design children's meals that make the healthy choice the easy choice.

The relationship between brand-specific alcohol advertising on television and brand-specific consumption among underage youth.

BACKGROUND: Being able to investigate the relationship between underage drinkers' preferences for particular brands and their exposure to advertising for those brands would represent a significant advance in alcohol marketing research. However, no previous national study has examined the relationship between underage youth exposure to brand-specific alcohol advertising and consumption of those brands. METHODS: We conducted a cross-sectional, Internet-based survey of a national sample of 1,031 youth, ages 13-20, who had consumed at least 1 drink of alcohol in the past 30 days. We ascertained all alcohol brands consumed by respondents in the past 30 days. The main outcome measure was brand-specific consumption during the past 30 days, measured as a dichotomous variable. The main predictor variable was exposure to brand-specific alcohol advertising on television. The respondents reported which of 20 television shows popular with youth they had watched during the past 30 days. For each respondent, we calculated a standard measure of potential exposure to the brand-specific alcohol advertising that aired on those shows during the preceding 12 months, based on Nielsen (New York, NY) estimates of the youth audience for each show's telecasts. RESULTS: Compared to no brand-specific advertising exposure, any exposure was associated with an increased likelihood of brand-specific consumption (adjusted odds ratio 3.02; 95% confidence interval: 2.61-3.49) after controlling for several individual- and brand-level variables. When measured as a continuous variable, the relationship between advertising exposure and brand consumption was nonlinear, with a large association at lower levels of exposure and diminishing incremental effects as the level of exposure increased. CONCLUSIONS: There is a robust relationship between youth's brand-specific exposure to alcohol advertising on television and their consumption of those same alcohol brands during the past 30 days. This study provides further evidence of a strong association between alcohol advertising and youth drinking behavior.

Young children's perceptions of health warning labels on cigarette packages: a study in six countries.

AIM: Health warning labels on cigarette packages are one way to reach youth thinking about initiating tobacco use. The purpose of this study was to examine awareness and understanding of current health warning labels among 5 and 6 year old children. SUBJECTS AND METHODS: Researchers conducted one-on-one interviews with urban and rural 5 and 6 year olds from Brazil, China, India, Nigeria, Pakistan, and Russia. RESULTS: Among the 2,423 participating children, 62 % were unaware of the health warnings currently featured on cigarette packages, with the lowest levels of awareness in India and the highest levels in Brazil. When shown the messages, the same percentage of participating children (62 %) showed no level of message understanding. CONCLUSION: While youth are receiving social and informational messages promoting tobacco use, health warning labels featured on cigarette packages are not effectively reaching young children with anti-smoking messages.

The Angelina effect: immediate reach, grasp, and impact of going public.

BACKGROUND: In May 2013, Angelina Jolie revealed in a New York Times opinion piece that she had undergone a preventive double mastectomy because she had a family history of cancer and carried a rare mutation of the BRCA1 gene. Media coverage has been extensive, but it is not obvious what messages the public took from this personal health story. METHODS: We conducted a survey with a representative national online panel of 2,572 adults. Participants described their awareness and identified information sources for the Angelina Jolie news story. They also reported their understanding, reactions, perceptions, and subsequent activities related to the story. We asked questions pertaining to personal and societal breast cancer risk and hypothetical questions regarding preventive surgery if the respondent or a family member were in the same position as Ms Jolie. Demographic information was collected, as was family risk for breast and ovarian cancer, and a gauge of numeracy. RESULTS: While three of four Americans were aware of Angelina Jolie's double mastectomy, fewer than 10% of respondents had the information necessary to accurately interpret Ms Jolie's risk of developing cancer relative to a woman unaffected by the BRCA gene mutation. Awareness of the Angelina Jolie story was not associated with improved understanding. CONCLUSION: While celebrities can bring heightened awareness to health issues, there is a need for these messages to be accompanied by more purposeful communication efforts to assist the public in understanding and using the complex diagnostic and treatment information that these stories convey.

International reach of tobacco marketing among young children.

BACKGROUND: Prosmoking messages, delivered through marketing and the media, can reach very young children and influence attitudes and behaviors around smoking. This study examined the reach of tobacco marketing to 5 and 6 year olds in 6 low- and middle-income countries. METHODS: Researchers worked one-on-one with 5 and 6 year olds in Brazil, China, India, Nigeria, Pakistan, and Russia (N = 2423). The children were asked to match logos with pictures of products, including 8 logos for cigarette brands. Analyses examined, overall and by country, whether gender, age, location, household use of tobacco, and knowledge of media characters were associated with awareness of cigarette brand logos. Additional analyses considered the relationship between cigarette brand logo awareness and intentions to smoke. RESULTS: Overall, 68% of 5 and 6 year olds could identify at least 1 cigarette brand logo, ranging from 50% in Russia to 86% in China. Across countries, being slightly older and having someone in the household who used tobacco, were significantly associated with greater odds of being able to identify at least 1 cigarette brand logo. CONCLUSIONS: The majority of young children from low- and middle-income countries are familiar with cigarette brands. This study's findings suggest that more effective measures are needed to restrict the reach of tobacco marketing.

Brand-specific consumption of alcohol among underage youth in the United States.

BACKGROUND: Little is known about brand-specific alcohol consumption among underage youth, as existing information is collected at the level of alcoholic beverage type. This study identifies the alcohol brands consumed by a nationally representative sample of underage youth in the United States. METHODS: We obtained a national sample of 1,032 underage youth, aged 13 to 20, using a pre-recruited Internet panel maintained by Knowledge Networks. Youth aged 18 to 20 were recruited directly from the panel via email invitation. Teens aged 13 to 17 were identified by asking adult panelists to identify a member of their household. The survey assessed the past 30-day consumption of 898 brands of alcohol among 16 alcoholic beverage types, including the frequency and amount of each brand consumed in the past 30 days. Market share for a given brand was calculated by dividing the total number of drinks for that brand in the past 30 days across the entire sample by the total number of drinks for all identified brands. RESULTS: The alcohol brands with highest prevalence of past 30-day consumption were Bud Light (27.9%, 95% confidence interval [CI] 23.3 to 32.4%), Smirnoff malt beverages (17.0%, 95% CI 12.9 to 21.1%), and Budweiser (14.6%, 95% CI 11.0 to 18.3%). Brand market share was concentrated in a relatively small number of brands, with the top 25 brands accounting for nearly half of all market shares. CONCLUSIONS: Underage youth alcohol consumption, although spread out over several alcoholic beverage types, is concentrated among a relatively small number of alcohol brands. This finding has important implications for alcohol research, practice, and policy.

Disordered eating in a digital age: eating behaviors, health, and quality of life in users of websites with pro-eating disorder content.

BACKGROUND: Much concern has been raised over pro-eating disorder (pro-ED) website communities, but little quantitative research has been conducted on these websites and their users. OBJECTIVE: To examine associations between levels of pro-ED website usage, disordered eating behaviors, and quality of life. METHODS: We conducted a cross-sectional, Internet-based survey of adult pro-ED website users. Main outcomes were Eating Disorder Examination Questionnaire (EDE-Q) and Eating Disorder Quality of Life (EDQOL) scores. RESULTS: We included responses from 1291 participants; 1254 (97.13%) participants were female. Participants had an average age of 22.0 years and a mean body mass index of 22.1 kg/m(2); 24.83% (296/1192) were underweight; 20.89% (249/1192) were overweight or obese. Over 70% of participants had purged, binged, or used laxatives to control their weight; only 12.91% (163/1263) were in treatment. Mean EDE-Q scores were above the 90th percentile and mean EDQOL scores were in the severely impaired range. When compared with moderate and light usage, heavy pro-ED website usage was associated with higher EDE-Q global (4.89 vs 4.56 for medium and 4.0 for light usage, P < .001) and EDQOL total scores (1.64 vs 1.45 for medium and 1.25 for light usage, P < .001), and more extreme weight loss behaviors and harmful post-website usage activities. In a multivariate model, the level of pro-ED website usage remained a significant predictor of EDE-Q scores. CONCLUSIONS: Pro-ED website visitors reported many disordered eating behaviors, although few had been treated. Heavy users reported poorer quality of life and more disordered eating behaviors.

Body image, eating disorders, and the relationship to adolescent media use.

Historically and currently, media messages around body shape and size emphasize the importance of being below-average weight for women and hypermuscular for men. The media messages around physical appearance are not realistic for most and lead to body dissatisfaction for most adolescents. Interventions designed to mitigate the influence of negative media messages on adolescents' body image are presented; however, most have shown limited success.